Alerts

COVID-19 Vaccine Information for Pharmacy Billing

4/16/2021

PDF Version 

TO:  All Pharmacy Providers

 

RE:   COVID-19 Vaccine Information for Pharmacy Billing


Alabama Medicaid will allow reimbursement to pharmacies for a vaccine administration fee to Medicaid providers who utilize federally-allocated COVID-19 vaccines. For claims effective March 15, 2021 and after, the reimbursement rate for the administration fee is $40.00 per dose, and will continue only during that time as described by the American Rescue Plan Act of 2021 that provides for increased FMAP for administration of the COVID-19 vaccine unless ended sooner by the Agency in a subsequent ALERT.

 

·   Pharmacies will bill vaccines through an electronic NCPDP claim.

o  Submit $0.00 or $0.01 for vaccine provided at no cost from the federal government. 

o  Submit each vaccine with the specific approved vaccine NDC for an eligible recipient.

o   Submit the administration fee in the Incentive Amount Submitted field (NCPDP Field 438-E3) on the same claim as the vaccine (i.e. ingredient).

o  Medicaid will allow for vaccine/administration with an effective date on/after December 28, 2020.

o   For claims on/after March 15, 2021, the administration fee is $40.00 per dose. 

o  Vaccines must be administered according to approved labeling for appropriate ages and dosing interval.

 

· Per the Public Readiness and Emergency Preparedness (PREP) Act, either    the Pharmacy or the Pharmacist NPI may be submitted on claims for COVID-19 vaccines only. 

o  Claims for administration of COVID-19 vaccines with the Pharmacy or Pharmacist NPI submitted in the prescriber field should be submitted with a SCC of 42 indicating that the prescriber ID submitted is valid and prescribing requirements have been validated. 

             

NCPDP Codes and Allowed Amounts for COVID-19 Vaccine Administration

Submission Clarification Code (440-E5)

Incentive Amount (Administration Fee 438-E3)

Ingredient Cost

(409-D9)

Two Dose Vaccines

First Dose

blank

$40.00

$0.00 or $0.01

Second Dose

blank

$40.00

$0.00 or $0.01

Single-Dose Vaccines

Single Dose

blank

$40.00

$0.00 or $0.01

 

 ·  The payment rate for COVID-19 vaccine administration is $40.00 to administer any dose of the vaccine. As of March 15, 2021, the Submission Clarification Code indicating which dose is being administered is no longer required.


· To participate in the administration of COVID-19 vaccine, Alabama providers must enroll in the Alabama Department of Public Health’s (ADPH) ImmPRINT COVID-19 Vaccination Program. Follow the steps in the ImmPRINT Registration Roadmap to enroll.


· Pharmacies must follow state and federal laws and regulations regarding administration of vaccines.


· State and federal standing order guidelines for products granted Emergency Use Authorization (EUA) must be followed.  Standing order guidelines can be found at the links below.

o  Moderna:

Moderna COVID-19 Vaccine: Standing Orders for Administering Vaccine to Persons 18 Years of Age and Older (cdc.gov)

o  Pfizer/BioNTech:

Pfizer-BioNTech COVID-19 Vaccine Standing Orders for Administering Vaccine (cdc.gov)

o  Janssen (Currently the FDA and CDC have paused the use of the Janssen vaccine.  More information can be found here: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/JJUpdate.html Should this pause be lifted, the Janssen standing order can be found here):

Janssen COVID-19 Vaccine (Johnson & Johnson): Standing Orders for Administering Vaccine to Persons 18 Years of Age and Older (cdc.gov)

 

Pharmacy providers with questions regarding vaccine administration may call the Alabama Medicaid Pharmacy Program at (334) 242-5050.